Journal of cardiac surgery · 2019
Outcomes of mitral valve surgery for severe ischemic mitral regurgitation.
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Dufendach Keith, Aranda-Michel Edgar, Sultan Ibrahim, Gleason Thomas G, Navid Forozan, Thoma Floyd, Kilic Arman
Аннотация
BACKGROUND: This study evaluated outcomes of mitral valve surgery for severe ischemic mitral regurgitation (IMR).
METHODS: Patients undergoing coronary artery bypass grafting (CABG) with concomitant mitral valve repair (MVr) or replacement (MVR) for severe IMR at a single center between 2010 and 2017 were included. The primary outcome was 5-year survival. Secondary outcomes included operative mortality and morbidity, hospital readmission, recurrence of at least moderate mitral regurgitation (MR), and mitral valve reoperation.
RESULTS: A total of 358 patients underwent concomitant mitral valve surgery with CABG for severe IMR (275 MVr and 83 MVR). Unadjusted and risk-adjusted operative mortality was higher in MVR (16% vs 8%; P = .04). MVR patients had higher rates of postoperative renal failure, prolonged ventilation, and deep sternal wound infection. The unadjusted 5-year survival was similar (MVR 64% vs MVr 64%; P = .41), a finding that persisted after risk-adjustment. The 5-year freedom from mitral valve reoperation was 96% and 97% (P = .47). Freedom from at least moderate MR at 1-year and 3-years was 100% vs 86% (P = .09) and 100% vs 68% (P = .06) for MVR and MVr, respectively. However, only three MVr patients developed severe MR by 3 years. Cumulative hazards for all-cause readmission and heart failure-specific readmission were higher with MVR.
CONCLUSIONS: Despite a trend towards higher risk of MR recurrence, patients undergoing MVr have similar rates of survival and mitral valve reoperation, with lower rates of readmission at 5-years. This, combined with lower operative mortality rates, makes MVr a reasonable choice particularly in sicker patients with higher operative risk and more limited life expectancy.
METHODS: Patients undergoing coronary artery bypass grafting (CABG) with concomitant mitral valve repair (MVr) or replacement (MVR) for severe IMR at a single center between 2010 and 2017 were included. The primary outcome was 5-year survival. Secondary outcomes included operative mortality and morbidity, hospital readmission, recurrence of at least moderate mitral regurgitation (MR), and mitral valve reoperation.
RESULTS: A total of 358 patients underwent concomitant mitral valve surgery with CABG for severe IMR (275 MVr and 83 MVR). Unadjusted and risk-adjusted operative mortality was higher in MVR (16% vs 8%; P = .04). MVR patients had higher rates of postoperative renal failure, prolonged ventilation, and deep sternal wound infection. The unadjusted 5-year survival was similar (MVR 64% vs MVr 64%; P = .41), a finding that persisted after risk-adjustment. The 5-year freedom from mitral valve reoperation was 96% and 97% (P = .47). Freedom from at least moderate MR at 1-year and 3-years was 100% vs 86% (P = .09) and 100% vs 68% (P = .06) for MVR and MVr, respectively. However, only three MVr patients developed severe MR by 3 years. Cumulative hazards for all-cause readmission and heart failure-specific readmission were higher with MVR.
CONCLUSIONS: Despite a trend towards higher risk of MR recurrence, patients undergoing MVr have similar rates of survival and mitral valve reoperation, with lower rates of readmission at 5-years. This, combined with lower operative mortality rates, makes MVr a reasonable choice particularly in sicker patients with higher operative risk and more limited life expectancy.